GERD (or gastroesophageal reflux disease) is a digestive disorder that causes acid from the stomach to flow up into the esophagus (aka the tube that helps food move from your mouth to your stomach). As you might imagine, this condition can cause some pretty uncomfortable GI symptoms, like heartburn, chronic cough, and nausea—especially after you’ve just finished a meal or if you lie down too quickly after eating. But you might experience one symptom that has nothing to do with your gut: back pain.

Back pain can stem from a ton of different sources. And if you regularly deal with acid reflux, it’s possible that GERD could be the culprit. “It’s not a common phenomenon, but I’ve had patients who’ve talked about it,” says Supriya Rao, M.D., a gastroenterologist with Tufts Medicine in Boston, MA. Here’s more about why exactly it happens and what you can do about GERD-related back pain.

How can GERD cause back pain?

When you have back pain from GERD, you’re dealing with something called referred pain—or pain that’s felt in a part of your body beyond the actual source of the pain. “A lot of nerve endings in the esophagus, where reflux occurs, get crisscrossed with nerve endings in the back muscles. So people might feel pain because of that crosstalk, often in between the shoulder blades,” Dr. Rao explains.

GERD-driven pain might extend to other areas too, like your neck, jaws, or arms, according to a paper published in Medscape General Medicine—which might freak you out a little bit, especially if you’ve never experienced it before. “People can get scared and think it’s cardiac-related,” Dr. Rao says. (FYI: pain caused by GERD isn’t a sign of a heart problem. But if the pain is severe or persistent and you’re not sure what you’re dealing with, it’s a good idea to see your healthcare provider for testing and treatment, if necessary.)

Are there any long-term complications of GERD-related back pain?

Referred pain from GERD isn’t going to do damage to your back or shoulders. But aside from just being unpleasant, unmanaged GERD can potentially cause some problems in the long run.

The biggest risk is that all that acid eventually starts to damage your esophageal tissue. That could result in long-term inflammation or scarring that narrows your esophagus, which in turn could make it harder to swallow, Dr. Rao says. The tissue damage can also lead to Barrett’s esophagus, a condition where your esophageal cells start to sustain harmful changes that raise the risk for esophageal cancer, notes the Mayo Clinic. So, if you’re experiencing heartburn and can’t figure out why, seeing your healthcare provider sooner rather than later can help you receive the treatment you need to prevent symptoms from worsening and causing potential complications.

How to treat GERD back pain

Speaking of treatment, you may be relieved to hear that several treatment options can help reduce GERD symptoms, including back pain. “Treating the reflux and changing your lifestyle around, all of those things can help [relieve symptoms’,” Dr. Rao says.

Here are some expert-approved treatment strategies:

• Limit or avoid foods that trigger your reflux: If you notice a certain food tends to give you heartburn, curbing your intake of that food will go a long way towards keeping the acid reflux at bay, or even getting rid of it completely, Dr. Rao says. Common triggers of GERD include fried or greasy foods, fatty or cheesy foods, spicy foods, tomato-based foods, citrus, chocolate, peppermint, and carbonated drinks, per Johns Hopkins Medicine.
• Take an over-the-counter (OTC) or prescription med: Antacids (which neutralize stomach acid) and proton pump inhibitors (which block the production of acid) can both help with acid reflux. OTC options like Mylanta, Rolaids, Tums, or Pepcid AC are good places to start, according to the U.S. Food and Drug Administration (FDA). If those aren’t doing enough to keep symptoms at bay, your healthcare provider can recommend a prescription-strength option that may work better for you.
• Manage a weight that’s right for you: Obesity is a common risk factor for GERD, so if you live with both GERD and obesity, weight management can help reduce symptoms. That’s because losing adipose tissue (aka body fat around your stomach) can take the pressure off, making it less likely for acid to retreat to the esophagus, according to the American Gastroenterological Association (AGA). Everyone’s weight management looks different, but eating a nutritious and well-balanced meal, making time for some physical activity every day, and drinking water is a good place to start.
• Avoid eating late: Aim to have dinner at least two to three hours before going to bed, the AGA recommends. Going to bed shortly after you eat is a recipe for reflux since lying down makes it easier for acid to flow up into your esophagus.
• Eat small, frequent meals: Big, heavy meals take longer to digest and put more pressure on your stomach, which increases the risk for reflux, the AGA notes.
• Elevate your head when you sleep: Prop another pillow under your head so you’re not lying flat. That’ll make it harder for reflux to flow up into your esophagus, Dr. Rao recommends.
• Drink plenty of water. Frequent sips of water can help clear some of the acid out of your esophagus, which can reduce painful symptoms, per a review published in Case Reports in Gastrointestinal Medicine.

Can you prevent GERD back pain?

Preventing back pain from GERD ultimately comes down to keeping that reflux at bay as much as possible. You can prevent painful symptoms by sticking to the same lifestyle changes that are recommended for treating GERD, Dr. Rao says. However, if lifestyle adjustments aren’t enough, taking medication to control your acid reflux can be helpful. Many people wonder if you have to take the medications forever, especially when living with a chronic condition like GERD, however, “it’s often possible to get off the meds once you initially get the GERD under control, provided you’re willing to stick with healthy lifestyle habits,” says Dr. Rao.

When to see a healthcare provider

You should let your healthcare provider know if you’re experiencing frequent acid reflux or other symptoms of GERD, especially if you’ve been trying to manage the problem on your own without success. They can run tests to look at the lining of your esophagus (like an upper endoscopy) to help give you an accurate diagnosis for GERD or check to see if treatment is working.

Also, keep in mind that while GERD can cause back pain, it’s also possible for people with GERD to have back pain for an entirely unrelated reason. So it’s also worth letting your provider know if your back continues to hurt even after your GERD is being managed. That helps you and your healthcare team explore other potential culprits of back pain and discuss treatment options to help you feel better.